Commonwealth of Virginia For DOAV Use Only

DATE STAMP BELOW

Department of Aviation
5702 Gulfstream Road
Richmond, VA 23250-2422
www.doav.virginia.gov

Application for Public-use Airport License or License Modification

Instructions
Use this application for requests for licenses or license modifications for public-use heliports.
Complete Parts 1 and 2.
Provide the supporting documents listed in Part 3, as appropriate.
Provide payment of the $25.00 fee, made payable to the Treasurer of Virginia.
Mail the application, all supporting documents, and fee to the Airport Services Division of the Virginia
Department of Aviation.

Part 1: Airport and Applicant Information

Type of application:
issuance of a license for new public-use airport
modification to a public-use airport license for a runway addition
modification to a public-use airport license for a runway extension
transfer of a public-use airport license due to change in ownership
modification to a public-use airport license due to airport name change **

Name of Airport:
**Previous Name if Modified:
Location of Airport:
(Provide direction and distance to nearest city or town or latitude and longitude of airport)

Name of Owner:
Address of Owner:

Name of Contact Person:

Phone for Contact Person:
Fax for Contact Person:
Email for Contact Person:

Part 2: Applicant Certification

The undersigned submits this application to the Virginia Department of Aviation in accordance with Code
of Virginia §§5.1-7 and 5.1-88.7 and Virginia Administrative Code Part III, Airports and Landing Areas, of
the Regulations Governing the Licensing and Operation of Airports and Aircraft and Obstructions to
Airspace in the Commonwealth of Virginia (24 VAC 5-20-10 et seg). The undersigned certifies that they
are the owner or the authorized representative for the owner of the airport for which this license is being
sought.
The undersigned acknowledges that the license requested will not be issued by the Virginia Department
of Aviation unless and until all supporting materials as noted herein have been properly submitted and
approved; any necessary hearings have been held and required reports have been prepared, submitted,
and accepted; and the Federal Aviation Administration has granted appropriate airspace for the safe
operation of the proposed or modified facility.

Signature of Owner or Authorized Representative Title

Date Phone

DOAV ASD02-1 Page 1 of 2 January 2009

 Application for Public-use Airport License or License Modification

Part 3: Supporting Documents

All of the following supporting documents must be submitted with the application for a new airport, the
addition of a new runway, or the extension of a runway:

signed copy of the resolution of the airport’s governing body or owner supporting or
requesting a new airport, the addition of a new runway, or the extension of a runway

copy of airport layout plan depicting the proposed airport, new runway, or runway extension

copy of airport property map (Exhibit A) depicting the proposed airport, new runway, or
runway extension
letter or documentation from the local jurisdiction that the proposed airport, new runway, or
runway extension complies with any local zoning ordinances and/or zoning requirements

copy of FAA Form 7480-1 Notice of Landing Area Proposal as submitted to FAA

copy of FAA’s determination in response to the Form 7480-1 submission

copy of Certificate of Financial Responsibility (DOAV ASD03-1) in accordance with Code of

Virginia §5.1-88.7
copy of environmental determination prepared pursuant to Code of Virginia §5.1-7 if
applicable

For the transfer of the license for a public-use airport, the following supporting documents must be
submitted with the application:

copy of sales agreement

copy of assumption agreement recorded by transferee

copy of Certificate of Financial Responsibility (DOAV ASD03-1) in accordance with Code of

Virginia §5.1-88.7

copy of the airport layout plan

copy of deed of transfer with airport property plat

copy of notification to FAA of ownership transfer that includes FAA site number; the location
identification of the airport; and the name, address, and phone of the new owner

For the change in an airport’s name, the supporting documentation is a copy of the notification to FAA of
the airport name change that includes FAA site number and the location identification of the airport.

Part 4: Virginia Department of Aviation Action (agency use only)

Application received:
Fee received:
Supporting materials received:
OAG review requested:
OAG response received:
License inspection conducted:
License issued or denied:

DOAV ASD02-1 Page 2 of 2 January 2009